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HHS Proposes New Rule to Implement HIPAA Standards for Healthcare Attachments and Electronic Signatures

The Secretary of the Department of Health and Human Services (HHS) has proposed a new rule that will require the adoption of standards for healthcare attachments transactions and electronic signatures used in conjunction with those transactions to support healthcare claims and prior authorization transactions. The new rule will implement the requirements of the Administrative Simplification Requirements of HIPAA and the Affordable Care Act and will apply to all health plans, healthcare clearinghouses, and healthcare providers that currently lack an efficient, uniform method of sending attachments.

Currently, when making coverage decisions about healthcare services, health plans often require additional information that cannot be added to the specified fields or data elements of the adopted prior authorization request or healthcare claims transaction. Currently, this information is sent through the mail or by fax and is subject to manual processes that consume considerable time and resources. At present, there are no adopted HIPAA standards, implementation guides, or operating rules covering healthcare attachments or electronic signatures. The proposed rule will support electronic transmissions of this type of information.

“We believe that the health care industry has long anticipated the adoption of a set of HIPAA standards for the electronic exchange of clinical and administrative data to support electronic health care transactions, such as prior authorization of services and claims adjudication, and the standards we are proposing to adopt are an important step in reducing provider burden,” explained the HHS.

The Administrative Simplification Rules of HIPAA called for standard-setting organizations (SSOs) to develop standard code sets for electronic healthcare transactions, and some of these have previously been implemented as part of the Transactions and Code Sets final rule. A rule was also proposed in 2005 – The HIPAA Administrative Simplification: Standards for Electronic Health Care Claims Attachments; Proposed Rule – that required the adoption of standards for health care claims attachment standards for specific service areas, including ambulance services, clinical reports, emergency department, laboratory results, medications, and rehabilitation services; however, based on the comments received, the HHS chose not to finalize that rule.

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The American Hospital Association (AHA) has announced its support for the proposed rule and the adoption of a new HIPAA standard for attachments and electronic signatures as this will ease the burden on providers. Currently, the lack of a HIPAA standard for attachment transactions slows down claims processing, leading to delays to payments and patient care, and contributes to provider burnout. “The AHA supports establishing a standard for attachments to reduce the administrative burdens facing clinicians, and we look forward to providing robust commentary after analyzing the rule’s specifics,” said Terrence Cunningham, AHA director of administrative simplification policy.

The proposed rule is scheduled to be published in the Federal Register on December 21, 2022. Comments on the proposed rule must be submitted by March 21, 2023.

Author: Steve Alder is the editor-in-chief of HIPAA Journal. Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. He is a specialist on healthcare industry legal and regulatory affairs, and has several years of experience writing about HIPAA and other related legal topics. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics.


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